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Urbanization and obesity-related chronic diseases are cited as threats to the future health of India's older citizens. With 50% of deaths in adult Indians currently due to chronic diseases, the relationship of urbanization and migration trends to obesity patterns have important population health implications for older Indians. The researchers constructed and calibrated a set of 21 microsimulation models of weight and height of Indian adults. The models separately represented current urban and rural populations of India's major states and were further stratified by sex.



Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat.


The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat.


In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries.


Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

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Globalization and Health
Brian K Chen
Ben Seligman
John W Farquar
Jeremy Goldhaber-Fiebert

Via Columbia 2
00133 Rome Italy

+39 06 7259 5606 +39 06 2020687
Associate Professor, Department of Economics and Finance - University of Roma

Vincenzo Atella is Associate Professor of Economics at the University of Rome "Tor Vergata" where he teaches Macroeconomics and courses in Applied Health Economics at graduate and post graduate level. He is also adjunct associate of the Center for Health Policy at Stanford where he has been visiting professor in different occasions.
Currently, he is CEIS Tor Vergata Director and Scientific Director of the Farmafactoring Foundation, member of SIVEAS (Health Care Services National Evaluation System) of the Ministry of Health, chief economist of the Italian Association of General Practitionners (Società Italiana di Medicina Generale – SIMG) and member and co-founder of the Italian Public Affair Association.

In the recent past he has been member of the International Committee of Experts advising IQWiG (the German Agency for Health Care) for setting national guidelines for Economic Evaluation and member of the Italian Committee for Drug Price appointed by the Ministry of Treasury. He also served as member of the “Strategic Evaluation Committee” of the Italian Drug Agency (AIFA), and has been consultant for the Italian Regional Agency for Health Care Services (, the National Institute of Health (, the WHO and the World Bank. Prof. Atella has been coordinator of a large European Research Network called TECH Europe ( which has received financial support by the European Science Foundation. His most recent research activity has focused on poverty, income distribution and health economics. In this last field his research deals with the introduction of new technologies in the health sector, the impact of different co-payment systems on pharmaceutical decision making by physicians and on drug consumption by patients, forecasting health expenditure and with health related income inequalities. The results of this research activity have been published on several international refereed journals as well books.

Director of the Centre for Economic and International Studies (CEIS) at the University of Rome “Tor Vergata”
Adjunct Affiliate at the Center for Health Policy and the Department of Medicine

Lee Kuan Yew School of Public Policy and Yong Loo Lin School of Medicine
National University of Singapore, Singapore 119260

(65) 6874-1540/4984 (65) 6779-1489
Professor at School of Public Policy and School of Medicine, National University of Singapore

Dr Phua Kai Hong holds joint appointments at the School of Public Policy and the School of Medicine, National University of Singapore, where he teaches health policy, health care management and health economics in the various graduate programs in public policy, public health and business administration. He was also an Adjunct Senior Fellow at the Institute of Policy Studies, Singapore. He graduated with honours cum laude from Harvard University and received graduate degrees from the Harvard School of Public Health (Master's in Health Services Administration & Population Sciences) and the London School of Economics & Political Science (PhD in Social Policy and Administration specializing in Health Economics). He was the recipient of a Harvard College Scholarship, the Sigma Scholarship from the Faculty of Arts and Sciences, Harvard University, and a National University of Singapore Overseas Graduate Scholarship.

Dr Phua has produced over 100 publications and papers in the field of health care management and related areas including the history of health services, health and population ageing, health economics and financing. He has contributed many international publications on comparative health policy, especially organizational and financing systems, and health sector reforms in the Asia-Pacific region. He is active as Chairman, Executive Board of the Asia-Pacific Health Economics Network (APHEN), Asian Health Systems Reform Network (DRAGONET), International Editorial Board member of Research in Healthcare Financial Management, International Association of Management Journal, and has also served as Associate Editor of the Asia-Pacific Journal of Public Health.

Dr Phua received The Outstanding Young Person of Singapore award in 1992 for his contributions to health policy and community service. He is currently a Vice-Chairman of the Singapore Red Cross, serves on the Board of Management of the Home Nursing Foundation and was a founder Council Member and Chairman, Resource Committee of the Gerontological Society. He was Chairman of the Task Force on Social Services 2015, to develop a strategic plan for the National Council of Social Service. He was appointed on many national advisory committees, including the Government Parliamentary Committee Resource Panel on Health (1988-1996), National Advisory Council on the Family and Aged (1989-1994), Review Committee on National Health Policies (1991-1992), Health Advisory Council, (1989-1992) and the Health Financing Sub-committee of the Economic Policy Review Committee (1989). He also served as Resource Person to the Workgroup on Health Care and Chairman of the Sub-workgroup on Resource Funding, in the Inter-Ministerial Committee on the Ageing Population (1999), Medical Hub Committee of the Economic Development Board and National Science & Technology Board (2001), Chairman of the Workgroup to Promote Singapore's Professional Services in the IPS Forum on Economic Restructuring (2002), and Chairman, Consumers Association of Singapores Committee on Transparency in Hospital Billing (2003-04).

At the corporate level, he was a past director of Health Management International Holdings and the NTUC Healthcare Cooperative. He has also consulted extensively for major multinational companies, including Baxter Healthcare, Johnson & Johnson, Merck Sharp & Dohme, Pfizer, Health Industry Manufacturers Association (HIMA) and the International Federation for Pharmaceutical Manufacturers Association (IFPMA). He has undertaken healthcare consulting assignments for numerous organizations and ministries of health in Singapore, Malaysia, Thailand, Indonesia, Philippines, Vietnam, Hong Kong, Taiwan, China, Mongolia, Korea and Japan. Internationally, he has served as Chairman, Technical Advisory Group on Health Sector Development of the World Health Organization Western Pacific Regional Office, and moderated the Ministerial Roundtable on Health and Poverty at the WHO Regional Meeting in 2000 and WHO Bi-Regional Meeting on Health Care Financing in 2005. He has consulted in health policy and management to many public, voluntary and international agencies within the Asia-Pacific region, including the Asia-Pacific Academic Consortium for Public Health, International Red Cross, Asian Development Bank, United Nations Economic Commission for the Asia-Pacific, World Bank and World Health Organization.

Stanford Health Policy Adjunct Affiliate
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