GENDER AND DEVELOPMENT: DIMENSIONS AND STRATEGIES – INTRODUCTION AND OVERVIEW

Achieving Gender parity has become a great concern for the world today. It is considered as a part of development strategy in many countries. When all people- both men and women have equal access to services and resources, enjoy equal rights, and get equal opportunity to develop capabilities without any bias or preferences , then the development of the country would be faster. It strengthens countries' abilities to grow, to reduce poverty, and to govern effectively. Despite considerable efforts in advocacy, creation of awareness, different strategies and programmes, Gender discrimination remains pervasive in many dimensions of life-worldwide. Though the nature and magnitude of the discrimination vary from country to country, in no part of the world gender parity is completely achieved in legal, social and economic fronts. Gender gaps are widespread in access to and control of resources, in economic opportunities, in power, and political voice. Women are still exploited, discriminated, and subject to harassment and violence. Again in the current years the focus has been changed from women empowerment to gender development. The former is a mean but not all for gender parity. In this perspective an edited volume covering the various dimensions and strategies of gender development is highly imperative. Rural women are mainly employed in agriculture-its allied activities and agro-based enterprises. There exists a glaring gender bias in terms of ownership , nature of works assigned, wages payment ,freedom in choice of work. Though the women contribute a significant proportion of agricultural production, they are discriminated, ill-paid and their role is largely neglected. There is a need for an appropriate legal-institutional frame work, change of societal attitude, and supported mechanization of agriculture on the need of lessening drudgery activities and work-stress for women, in reducing gender disparity in agriculture sector and sustainable development. Similarly the women, nearly half of the total population, are lagging behind in access to the existing health care and educational opportunities in the country. A proper level of awareness and conducive environment need to be developed for this. Promotion of health, education and an appropriate level of awareness will largely contribute to women development and facilitate them to enjoy their right. More over provision of employment and economic empowerment of women can be considered as one of the important dimensions of gender development. Formation of Self Help Group among poor women those are unable to access market individually, on their own capacity and provision of micro credit financing to them are great support and help them to start income generating micro enterprises and get rid of poverty. This not only helps to empower women but also provides them economic and social justice. This is an initiative to address these issues and draw the attention of the policy makers and planners.Women in Development, Gender and Development

Vibration, Buckling and Parametric Instability of Delaminated Composite Panels in Hygrothermal Environment

The present investigation deals with free vibration, static and dynamic stability performance of bidirectional delaminated composite flat and curved panels with inplane periodic loading in hygrothermal environment.The dynamic instability under in-plane periodic forces for delaminated woven fiber composite panels are studied in varying environmental conditions of temperature and moisture using finite element method (FEM). Numerical analysis by FEM and experimental studies are conducted on free vibration and buckling response of bidirectional delaminated composite panels in hygrothermal environment. The influences of various parameters such as hygrothermal conditions, area and strip delaminations, boundary conditions, ply orientations, stacking sequence, curvatures, static and dynamic load factors on the free vibration, static and parametric instability characteristics of bidirectional composite panels are considered in the present study. A finite element model is developed having 8-noded isoparametric element with 5 degrees of freedom (DOF) per node for the vibration, static and dynamic instability characteristics of delaminated bidirectional composite flat and curved panels under hygrothermal environment utilizing first order shear deformation theory (FSDT). Principal instability zones are located by solutions of Mathieu-Hill equations using Bolotins approach. Based on principle of minimum potential energy, the elastic stiffness matrix, geometric stiffness matrix due to hygrothermal and applied loads, mass matrix and load vectors are formulated. Provision for area and strip delamination modeling is also made in the numerical analysis using multi-point constraint algorithm. A general formulation for vibration, buckling and dynamic stability characteristics of bidirectional delaminated composite flat and curved panels under in-plane periodic forces is presented.The materials utilised for casting of specimens are bidirectional Glass fiber, epoxy as resin, hardener, polyvinyl alcohol as a releasing agent and Teflon film for introducing artificial delaminations. The material constants are calculated from the tensile tests of coupons under varying temperature and moisture conditions as per appropriate ASTM standards. For free vibration testing, FFT analyzer with PULSE Labshop software is used. A test set up is fabricated for vibration test of composite plates under different boundary conditions.The Universal testing machine INSTRON 8862 is used for determination buckling loads experimentally. A good matching is observed between predicted and test results for free vibration and buckling of delaminated composite panels in hygrothermal field. The natural frequencies and buckling loads are observed to decrease with increase in delamination at elevated temperature and moisture conditions under different boundary conditions. However, an increment in the fundamental frequencies is found at sub-zero temperatures up to cryogenic range as against ambient conditions because of development o

GENDER AND DEVELOPMENT: DIMENSIONS AND STRATEGIES – INTRODUCTION AND OVERVIEW

Achieving Gender parity has become a great concern for the world today. It is considered as a part of development strategy in many countries. When all people- both men and women have equal access to services and resources, enjoy equal rights, and get equal opportunity to develop capabilities without any bias or preferences , then the development of the country would be faster. It strengthens countries' abilities to grow, to reduce poverty, and to govern effectively. Despite considerable efforts in advocacy, creation of awareness, different strategies and programmes, Gender discrimination remains pervasive in many dimensions of life-worldwide. Though the nature and magnitude of the discrimination vary from country to country, in no part of the world gender parity is completely achieved in legal, social and economic fronts. Gender gaps are widespread in access to and control of resources, in economic opportunities, in power, and political voice. Women are still exploited, discriminated, and subject to harassment and violence. Again in the current years the focus has been changed from women empowerment to gender development. The former is a mean but not all for gender parity. In this perspective an edited volume covering the various dimensions and strategies of gender development is highly imperative. Rural women are mainly employed in agriculture-its allied activities and agro-based enterprises. There exists a glaring gender bias in terms of ownership , nature of works assigned, wages payment ,freedom in choice of work. Though the women contribute a significant proportion of agricultural production, they are discriminated, ill-paid and their role is largely neglected. There is a need for an appropriate legal-institutional frame work, change of societal attitude, and supported mechanization of agriculture on the need of lessening drudgery activities and work-stress for women, in reducing gender disparity in agriculture sector and sustainable development. Similarly the women, nearly half of the total population, are lagging behind in access to the existing health care and educational opportunities in the country. A proper level of awareness and conducive environment need to be developed for this. Promotion of health, education and an appropriate level of awareness will largely contribute to women development and facilitate them to enjoy their right. More over provision of employment and economic empowerment of women can be considered as one of the important dimensions of gender development. Formation of Self Help Group among poor women those are unable to access market individually, on their own capacity and provision of micro credit financing to them are great support and help them to start income generating micro enterprises and get rid of poverty. This not only helps to empower women but also provides them economic and social justice. This is an initiative to address these issues and draw the attention of the policy makers and planners

GENDER AND DEVELOPMENT: DIMENSIONS AND STRATEGIES – INTRODUCTION AND OVERVIEW

Achieving Gender parity has become a great concern for the world today. It is considered as a part of development strategy in many countries. When all people- both men and women have equal access to services and resources, enjoy equal rights, and get equal opportunity to develop capabilities without any bias or preferences , then the development of the country would be faster. It strengthens countries' abilities to grow, to reduce poverty, and to govern effectively. Despite considerable efforts in advocacy, creation of awareness, different strategies and programmes, Gender discrimination remains pervasive in many dimensions of life-worldwide. Though the nature and magnitude of the discrimination vary from country to country, in no part of the world gender parity is completely achieved in legal, social and economic fronts. Gender gaps are widespread in access to and control of resources, in economic opportunities, in power, and political voice. Women are still exploited, discriminated, and subject to harassment and violence. Again in the current years the focus has been changed from women empowerment to gender development. The former is a mean but not all for gender parity. In this perspective an edited volume covering the various dimensions and strategies of gender development is highly imperative. Rural women are mainly employed in agriculture-its allied activities and agro-based enterprises. There exists a glaring gender bias in terms of ownership , nature of works assigned, wages payment ,freedom in choice of work. Though the women contribute a significant proportion of agricultural production, they are discriminated, ill-paid and their role is largely neglected. There is a need for an appropriate legal-institutional frame work, change of societal attitude, and supported mechanization of agriculture on the need of lessening drudgery activities and work-stress for women, in reducing gender disparity in agriculture sector and sustainable development. Similarly the women, nearly half of the total population, are lagging behind in access to the existing health care and educational opportunities in the country. A proper level of awareness and conducive environment need to be developed for this. Promotion of health, education and an appropriate level of awareness will largely contribute to women development and facilitate them to enjoy their right. More over provision of employment and economic empowerment of women can be considered as one of the important dimensions of gender development. Formation of Self Help Group among poor women those are unable to access market individually, on their own capacity and provision of micro credit financing to them are great support and help them to start income generating micro enterprises and get rid of poverty. This not only helps to empower women but also provides them economic and social justice. This is an initiative to address these issues and draw the attention of the policy makers and planners

Long-term trends of direct nitrous oxide emission from fuel combustion in South Asia

An increasing concentration of nitrous oxide (N2O) in the global atmosphere can perturb the ecological balance, affecting the climate and human life. South Asia, one of the world's most populous regions, is a hotspot for N2O emission. Although agriculture traditionally dominated the region, economic activities are rapidly shifting towards industry and energy services. These activites may become the largest emitters of N2O in future. Yet, few attempts have been made to estimate long-term direct N2O emission from fuel combustion for the different energy-consuming sectors in the South Asian region. Therefore, the present study developed a comprehensive sectoral N2O emission inventory for South Asian countries for the time period of 1990–2017, with projections till 2041. It revealed that the average N2O emission from fuel combustion in the South Asia region is about 40.96 Gg yr−1 with a possible uncertainty of ±12 Gg yr−1, showing an increase of more than 100% from 1990 to 2017. Although India is the major contributor, with an average of 34 Gg yr−1 of N2O emissions, in terms of growth, small countries like Bhutan and Maldives are dominating other South Asian countries. Sector-wise, the residential sector contributed a maximum emission of 14.52 Gg yr−1 of N2O but this is projected to reduce by more than 50% by 2041. This is because of the successful promotion of cleaner fuels like liquefied petroleum gas over more polluting fuelwood. Power generation contributed 9.43 Gg yr−1of N2O emissions, exhibiting a maximum growth of 395%, followed by road transport (289%) and industry (231%). Future N2O emissions from transport, power and industry are projected to rise by 2.8, 3.3, and 23.9 times their 2017 estimates, respectively, due to the incapability of current policies to combat rising fossil fuel consumption. Mitigation options, such as replacing diesel and compressed natural gas vehicles with electricity-driven vehicles, can decelerate N2O emissions to 45% by 2041 for road transport. A 41% reduction is possible by displacing coal with renewables in the power and industry sectors. Overall, the South Asian contribution to global N2O emissions has enlarged from 2.7% in 1990 to 5.7% in 2007–2016, meaning there is an urgent need for N2O emission mitigation in the region

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe