The Nutrition Transition and its Health Implications in Lower-income Countries 249rapidly, industrial production is dominated by capital-intensive processes and
time-allocation patterns change dramatically. Associated socioeconomic changes
especially important in the nutrition transition phenomenon are (a) changes in the
role of women (especially with respect to patterns of time allocation); (b) changes
in income patterns; (c) changes in household food-preparation technology; (d)
changes in food production and processing technology; and (e) changes in family
and household composition.
The sectoral distribution of the labour force towards industry and service has
accelerated around the world. Figure 12.3 presents data on this pattern for higher-
and lower-income countries. It shows for all lower-income countries a pronounced
move away from agriculture and towards manufacturing and service employment.
As has often been shown, the most labour-intensive agricultural work requires the
greatest amount of energy expenditure. One of the most inexorable shifts with
modernization and industrialization is the reduced use of human energy to pro-
duce more capital-intensive manufacturing and goods and services. The result is
obviously a marked shift in activity patterns at work, a trend particularly associated
with our shift into increasingly capital-intensive production and increasingly sed-
entary manufacturing, service and commercial work. This within-occupation shift
in energy expenditure cannot readily be shown with national data. It requires indi-
vidual level information.
Unfortunately, few longitudinal studies attempt to measure physical activity
and energy expenditures. One quite simple measure of overall activity has been
collected in each survey from 16,000 Chinese as part of the CHNS. Table 12.4
shows the shifts in the proportion of Chinese adults involved in low levels of
physical activity at work. In particular, urban residents in all income groups were
more likely in 1993 to have adopted a more sedentary activity pattern. Elsewhere,
Source: World Bank, 53 countries, over a 23-year period
Figure 12.3 Shifts in the distribition of occupation, 1972–1995