• Course Title: NUTRITION POLICY AND PUBLIC

HEALTH
• Course Code: HND-504
• Credit Hours: 3(3-0)
• THEORY
• Global public health and nutrition: issues, policies and strategies.
Ecological level strategies for public health nutrition. Key principles
and guidelines to design nutrition interventions and dietary habits.
Nutrition strategies for individual level intervention: introduction,
supplementary feeding. Dietary guidelines; introduction, dietary
recommendations, quantitative and qualitative dietary guidelines,
devising food-based dietary guidelines. Food choice: International
food and nutrition legislation and policies.
• BOOKS RECOMMENDED
• Gibney, M. J., B. M. Margetts, J. M. Kearney, and L. Arab. 2004.
Public health nutrition. Wiley-Blackwell Publishing, London, UK
• Spark, A. 2007. Nutrition in public health: principles, policies, and
practice. CRC Press. Taylor and Franics Group, New York, USA
Basics of Public Health

GCUF- Pakistan
 Overview

• Questions to be addressed:
– What is public health?
– What is a public health system?
– Why take a public health approach?
– Can public health make a difference?
 What is Public Health?
Definitions vary

• “Assure conditions in which people can be healthy.”

• Public Health as the science and art of preventing disease,

prolonging life, and promoting physical health and efficiency
through organized community efforts for the sanitation of the
environment, the control of community infections, the education
of the individual in principles of personal hygiene, the
organization of medical and nursing services for the early
diagnosis and preventive treatment disease, and the
development of the social machinery which will ensure to every
individual in the community a standard of living adequate for the
maintenance of health.
•
What is Public Health?
Definitions vary

• Public Health is one of the efforts organized by society to protect,

promote, and restore the peoples’ health.

• Public health is the combination of sciences, skills, and beliefs that

is directed to the maintenance and improvement of the health of all
the people through collective or social actions.
 Public Health
~Vision~
Healthy People in Healthy Communities

Promote physical and mental health

and
Prevent disease, injury, disability
 Public Health…
• Prevents epidemics and the spread
of disease

• Protects against environmental

hazards

• Responds to disasters and assists

communities in recovery
 Public Health…

• Prevents injuries

• Promotes healthy behaviors

• Assures the quality and

accessibility of health services
 Public Health…
• Three core functions
– Assessment
– Policy Development
– Assurance
Core Components/functions

POLICY
ASSESSMENT
DEVELOPMENT
of the health of
in the public’s
the community
interest

ASSURANCE
of the public’s
health
A Public Health System
A Public Health System
10 Essential Services
1. Monitor health status
to identify community
health problems

2. Diagnose and investigate

health problems and health
hazards in the community
10 Essential Services
3. Inform, educate, and
empower people about
health issues

4. Mobilize community partnerships

to identify and solve
health problems
10 Essential Services
5. Develop policies and
plans that support
health efforts

6. Enforce laws and regulations that

protect health and
ensure safety
10 Essential Services
7. Link people to personnel
health services and
assure the provision of
health care

8. Assure a competent public health

and health care
workforce
10 Essential Services
9. Evaluate the effectiveness,
accessibility, and quality
of services

10. Research for new insights and

innovative solutions to
health problems
A Public Health System
• Who?
– Public entities
– Private entities
– Voluntary entities

• How?
– A network
 A Public Health System
The Public Health System
Police
Home Health
Community Corrections
Centers
Health
Department
Parks

Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
 Workforce
• Diverse and Multidisciplinary
• Examples…
 Biostatisticians

 Dieticians
 Health services administration
 Environmental Health Specialists
 Behavioral Health Specialists
Public Health Approach
Public Health Medical
Model Versus Model
Determinants of Health
Determinants of Health
• Genetic
• Behavioral
• Social
• Environmental
• Personal
health care
 Achievements

• Vaccination

• Safer Workplaces

• Safer & Healthier Food

• Motor Vehicle Safety

 Achievements
• Control of Infectious
Diseases

• Family Planning

• Decline in Deaths from

Heart Disease & Stroke
 Achievements
• Recognition of Tobacco
Use as a Health Hazard

• Healthier Mothers
and Babies

• Fluoridation of Drinking
Water
Public health Nutritionist
• Public health nutritionists are engaged:
– Public health nutrition activities.
– data analysis
skills and are proficient in community development,
program planning, program management, program
evaluation, budget development, and policy analysis
and development.
– Include mid level planners, researchers, and teachers,
administrators, and directors of research and training
programs.
– Function as macro planners, decision makers, and heads
of governmental sectors
• Active communication among public health
nutritionists and community nutritionists is
highly valued, it is most likely that midlevel
planners, researchers, and teachers will
interact most with professionals at the
community level and with upper-level
public health nutritionists
Public health Nutritionist
• Public health nutritionists are engaged:
– Public health nutritionists provide leadership in assessing the
need for public health nutrition campaigns planning, and
evaluating them.
– They are also responsible for assuring compliance with
laws and regulations regarding the provision of community
nutrition services and assuring competence of the nutrition
workforce.
– Public health nutrition professionals are employed by the
public (that is, government or tax supported) sector, as
opposed to being employed by the private (for-profit) sector.
Public health Nutritionist
 How to train public Health
Nutrition Professionals
1. To acquire detailed knowledge regarding the biological basis of
nutrition and the mechanisms by which diet can influence
health
2. To develop the ability to translate research into practice through
skills in nutrition surveillance, policy, program planning and
evaluation, management, oral and written communication, and
information dissemination
3. To gain an interdisciplinary perspective on public nutrition in
both its domestic and international context
4. To develop the necessary quantitative skills in biostatistics
required for the evaluation of diet and disease relationships in
epidemiologic studies
 How to train public Health
Nutrition Professionals

5. Attain skills in developing research proposals that

require the integration of knowledge about human
nutrition with epidemiologic concepts in order to
improve diet and activity and reduce disease risk
in populations
 TRAINING OF COMMUNITY NUTRITION
PROFESSIONALS

1. Manage nutrition care for diverse population groups

across the life span
2. Conduct outcome assessment/evaluation of a
community-based food and nutrition program
3. Develop community-based food and nutrition
programs
4. Participate in nutrition surveillance and monitoring
of communities
5. Participate in community-based research
 TRAINING OF COMMUNITY NUTRITION
PROFESSIONALS

1. Participate in food and nutrition policy development and

evaluation based on community needs and resources
2. Consult with organizations regarding food access for target
populations
3. Develop a health promotion/disease prevention intervention
project
4. Conduct general health assessment, such as blood pressure and
vital signs
Global Distribution of Causes of Child
Deaths
Global health and Nutrition
 The Importance of Nutrition
• Nutritional status is intimately linked with
health status
• Nutrition is the leading risk factor for loss
of health in low- and middle-income
countries
• Low-cost, highly effective interventions
are available to improve nutrition status
 Definitions and Key Terms
• Malnutrition - refers to those who do not get
proper nutrition, whether too little, too much,
or the wrong kind
• Undernourished - refers to those who lack
sufficient energy or nutrients
• Underweight - refers to those who have low
weight for their height or age
• Overweight or obese - refers to those who are
nourished to the point of being too heavy for
their height or age
 Table 8.3: Key Terms and Definitions

Source: Adapted with permission from The World Bank. Repositioning Nutrition as Central to Development . Washington, DC: The World
Bank;
2006:xvii.
Key Terms and Definitions (cont.)
 The Determinants of Nutritional
Status
Immediate causes of malnutrition:
• Inadequate dietary intake- weakens the
body and opens it up to infection
• Illness- makes it harder for people to eat,
absorb the nutrients they take in, and
raises the need for some nutrients
Relationship creates a cycle of illness and
infection
The Determinants of Nutritional Status:
The UNICEF Framework
 Gauging Nutritional Status
• Nutritional status of infants and children is
gauged by measuring and weighing them,
then plotting weight and height on a growth
chart
• Child’s position on growth curve indicates if
they are developing normally
• Large share of nutritional deficits are mild,
but still have negative consequences on
development
 Key Nutritional Needs
Undernutrition
• Outcome of insufficient food intake and
repeated infectious disease
• Includes underweight, stunted, wasted, and
micronutrient malnutrition
• Raises risk of illness and decreased
intellectual capacity in children
• Raises risk of pregnancy-related death and
delivering prematurely in women
 Nutritional State of the World
Undernutrition
• 26% of under-5 children are underweight
according to most recent estimates
• Rates of underweight vary considerably by
region
• Only about 0.5% of total deaths in low- and
middle-income countries are directly due
to undernutrition
• Deaths are usually “nutrition related”
 Nutritional State of the World
Low Birthweight
• 11% of babies in low- and middle-income
countries are born low birthweight
according to recent estimates
• About 3% of DALYs lost in low- and middle-
income countries are attributable to low
birthweight
 Food and nutrition security
Situation in which all people at all times
have physical, social and economic access
to food that is safe, consumed in sufficient
quantity and quality to meet their dietary
needs and food preferences, and supported
by an environment of adequate sanitation,
health services and care, allowing for a
healthy and active life.
 Food security
• situation in which all people at all times
have physical, social and economic
access to sufficient safe, nutritious food
to meet their dietary needs and food
preferences for an active and healthy life.
The four pillars of food security are
availability, access, utilization and stability.
 Nutrition Surveillance
continual monitoring
in a community, region or country
 factors or conditions
relate to or impinge on the nutritional
status of individuals or groups of people.
 Direct or indirect indicators  collected,
analysed, interpreted and disseminated
 used in planning, implementing and
evaluating nutrition policies and
programmes.
 Key Nutritional Needs
Vitamin A
• Deficiency associated with night blindness
and eventually, permanent blindness
• Important to growth and the proper
functioning of the immune system
• Impact on severity of illness and chance of
survival from several causes, including
diarrhea, malaria, and pneumonia
 Nutritional State of the World
Vitamin A
• About 250 million children suffer from
vitamin A deficiency worldwide
• 6.5% of all deaths of children under-5 in
low- and middle-income countries are due
to vitamin A deficiency
 Key Nutritional Needs
Iodine
• Deficiency associated with a growth on
the thyroid called a goiter and the failure
to develop full intellectual potential
• Occurs in people who live in mountainous
regions where less seafood is consumed
and the soil is deficient in iodine
 Nutritional State of the World
Iodine
• About 70 million people worldwide are
affected by iodine deficiency
• Associated with substantial DALYs lost in
low- and middle-income countries
 Key Nutritional Needs
Iron
• Deficiency causes iron deficiency anemia
which is associated with fatigue and
weakness
• Iron-deficient pregnant women have an
increased risk of giving birth to a
premature or low birthweight baby or
hemorrhaging and dying in child birth
 Nutritional State of the World
Iron
• About 1.6 billion people were affected by
anemia between 1993 and 2005
• Substantial public health problem for children
under 5 and pregnant women, especially in
low- and middle-income countries
• 0.7% of DALYs lost in low- and middle-income
countries is related to iron deficiency anemia
 Key Nutritional Needs
Zinc
• Deficiency is associated with growth
retardation, impaired immune function,
skin disorders, hypogonadism, and
cognitive dysfunction
• Deficiency is a major risk factor for
morbidity and mortality from diarrhea,
pneumonia, and malaria
 Nutritional State of the World
Zinc
• Second most important micronutrient
responsible for death and DALYs in
children under 5
• About 4% of DALYs lost in children under 5
years of age are due to zinc deficiency
 Nutritional Needs Throughout the
Life Cycle
Pregnancy and Birthweight
• Pregnant women need a sufficient amount
of protein and energy as well as iron,
iodine, folate, zinc, and calcium
• Fetuses that do not get sufficient nutrition
from the mother may suffer from stillbirth,
mental impairment or birth defects
 Nutritional Needs Throughout the
Life Cycle
Infancy and Young Childhood
• Children need sufficient protein and energy
as well as iodine, iron, vitamin A, and zinc
• Nutritional gaps during this time can cause
problems with stature and mental
development, and frequent infection
• Grow best and stay healthiest if exclusively
breastfed for first 6 months
• “Window of opportunity” is in utero to two
years of age
 Nutritional Needs Throughout the
Life Cycle
• Adolescents need protein and energy to
grow as well as iron, iodine, folic acid, and
calcium
• Adolescent girls who are poorly nourished
are much more likely to give birth to an
underweight child and experience
complications during pregnancy than well-
nourished girls
 Nutritional Needs Throughout the
Life Cycle
Adulthood and Old Age
• Adults need a well-balanced diet with
protein, energy, and iron
• Foods that contain too much fat,
cholesterol, sugar, or salt can be harmful
• Older adults need calcium to reduce risk
of osteoporosis
 Nutrition, Health, and Economic
Development
• Nutrition impacts health and human
development
• Link to what people learn and their
productivity
Poor nutrition:
• Impacts maternal health, which affects
household income and health of children
• Affects children’s ability to learn in school,
which impacts their future prospects
• Leads to lower productivity in adult workers