Christopher A. Tait

Female life expectancy and mortality rates have been improving over the course of many decades. Many global changes offer potential explanations. In this paper, we examined whether the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) has, in part, been responsible for the observed improvements in these key population metrics of women’s health. Data were obtained from the United Nations Treaty Series Database, the World Bank World Development Indicators database and, the Polity IV database. Because CEDAW is nearly universally ratified, it was not feasible to compare ratifying countries to non-ratifying countries. We therefore applied interrupted times series analyses, which creates a comparator (counterfactual) scenario by using the trend in the health outcome before the policy exposure to mathematically determine what the trend in the health outcome would have been after the policy exposure, had the policy exposure not occurred. Analyses were stratified by country-level income and democratization. Among low-income countries, CEDAW improved outcomes in democratic, but not non-democratic countries. In middle-income countries, CEDAW largely had no effect and, among high-income countries, had largely positive effects. While population indicators of women’s health have improved since CEDAW ratification, the impact of CEDAW ratification itself on these improvements varies across countries with differing levels of income and democratization.

A pervasive and persistent finding is the health disadvantage experienced by those in food insecure households. While clear associations have been identified between food insecurity and diabetes risk factors, less is known about the relationship between food insecurity and incident type 2 diabetes. The objective of this study is to investigate the association between household food insecurity and the future development of type 2 diabetes. We used data from Ontario adult respondents to the 2004 Canadian Community Health Survey, linked to health administrative data (n = 4,739). Food insecurity was assessed with the Household Food Security Survey Module and incident type 2 diabetes cases were identified by the Ontario Diabetes Database. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes as a function of food insecurity. Canadians in food insecure households had more than 2 times the risk of developing type 2 diabetes compared to those in food secure households [HR = 2.40, 95% CI = 1.17–4.94]. Additional adjustment for BMI attenuated the association between food insecurity and type 2 diabetes [HR = 2.08, 95% CI = 0.99, 4.36]. Our findings indicate that food insecurity is independently associated with increased diabetes risk, even after adjustment for a broad set of measured confounders. Examining diabetes risk from a broader perspective, including a comprehensive understanding of socioeconomic and biological pathways is paramount for informing policies and interventions aimed at mitigating the future burden of type 2 diabetes.